DOMS EARLY REINTERVENTION (ERI) EXPERIMENT

DOMS 早期再干预 (ERI) 实验

• 批准号: 6378714
• 负责人: MICHAEL L DENNIS
• 金额: $ 54.07万
• 依托单位: CHESTNUT HEALTH SYSTEMS, INC.
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-08-01 至 2003-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6378714
• 关键词: behavior therapy; clinical research; drug abuse prevention; drug abuse therapy; health care service utilization; human subject; human therapy evaluation; interview; motivation; outcomes research; patient care management; relapse /recurrence; social support network; substance abuse related behavior

While most clinicians view substance use as a chronic relapsing condition that may require multiple episodes of care, most research to date has focused on single episodes of care. Recent emphasis on outcome based contracts and/or capitated cost contracts has stimulated interest in better managing clients "across" multiple admissions and/or in a continuum of care model. In the treatment of other chronic illnesses quarterly, semi-annual or annual check-ups are often integral parts of aftercare which check for early indications of relapse and attempt early re-intervention before the condition and consequences worsen. The specific aims of this study are to determine the relative effectiveness of an Early Re-Intervention (ERI) protocol in terms of its ability to: 1) reduce the time to treatment re-entry and increase the rates of early treatment re-entry, and, 2) improve long-term outcomes related to a) substance use, HIV risk behaviors, illegal activity, b) training- and employment-related behaviors, and c) utilization of expensive services (e.g., inpatient substance abuse treatment, inpatient mental health treatment, emergency room admissions, hospital nights, days in jail, days of their children being in foster care or institutions). To evaluate ERI, 800 new clients with substance use disorders will be recruited from two central intake units, one located in Chicago and another in Central Illinois. Clients will be blocked into one of five severity groups (based on drug dependence, alcohol dependence, and frequency of use) then randomly assigned to either quarterly outcome monitoring (OM) with 20-30 minute assessments for 18 months or quarterly OM plus ERI. Response of participants in the ERI condition will be used to determine the participants linkage assistance needs every quarter. ERI Linkage Managers will provide the qualified participants with linkage assistance including feedback on their current substance use and need for treatment, motivational discussions to convince them to consider returning to treatment, and then direct assistance in helping them make and keep a readmission appointment. Through feedback, social reinforcement, and assistance to access care, ERI is expected to reduce the time to readmission, increase the rate of early treatment re-admissions, and consequently, improve long-term outcomes. Significant findings in favor of the ERI protocol would provide a better understanding of the clinical value of outcome monitoring and a straightforward, replicable protocol for improving the long-term effectiveness of drug treatment.

虽然大多数临床医生将药物滥用视为一种慢性复发性疾病，可能需要多次护理，但迄今为止大多数研究都集中在单次护理上。 最近对基于结果的合同和/或按人头成本合同的强调激发了人们对“跨”多次入院和/或连续护理模式更好地管理客户的兴趣。在每季度治疗其他慢性疾病时，每半年或每年进行一次检查通常是术后护理的组成部分，检查复发的早期迹象，并在病情和后果恶化之前尝试早期重新干预。 本研究的具体目的是确定早期再干预 (ERI) 方案在以下方面的相对有效性：1) 减少重新进入治疗的时间并提高早期重新治疗的比率， 2) 改善与以下方面相关的长期结果：a) 物质使用、艾滋病毒危险行为、非法活动，b) 培训和就业相关行为，以及 c) 使用昂贵的服务（例如住院药物滥用治疗、住院精神治疗）健康治疗、紧急情况入院、入院过夜、入狱天数、孩子在寄养或机构中的天数）。为了评估 ERI，将从两个中心接收单位招募 800 名患有药物滥用障碍的新客户，一个位于芝加哥，另一个位于伊利诺伊州中部。 客户将被分为五个严重程度组之一（根据药物依赖、酒精依赖和使用频率），然后随机分配到季度结果监测 (OM)（为期 18 个月，进行 20-30 分钟的评估）或季度 OM 加 ERI。 参与者在 ERI 条件下的响应将用于确定每季度参与者的联动援助需求。 ERI 联动经理将为合格的参与者提供联动协助，包括对他们当前的药物使用和治疗需求的反馈、说服他们考虑重返治疗的动机讨论，然后直接协助他们进行和保留重新入院预约。 通过反馈、社会强化和帮助获得护理，ERI 预计将减少再入院时间，提高早期治疗再入院率，从而改善长期结果。支持 ERI 方案的重大发现将有助于更好地理解结果监测的临床价值，并提供一个简单、可复制的方案来提高药物治疗的长期有效性。